Saturday, December 28, 2013

Insurance Commission Bulletin IC-37: GENDER IDENTITY NONDISCRIMINATION REQUIREMENTS

The actual bulletin from the Insurance Commission is here.

It reads in part,
Categories of Health Insurance: As described above, discrimination in handling of claims for medically necessary treatment of gender dysphoria is prohibited. This prohibition extends to the categories of health insurance covered under sections 38a-488a [Individual and Group Mental Health Parity Statute - individual health insurance] and 38a-514 [Individual and Group Mental Health Parity Statute - group health insurance ] of the Connecticut General Statutes, specifically categories (1), 2), (4), (11) and (12) under section 38a-469 of the Connecticut General Statutes. These categories are basic hospital expense coverage, basic medical-surgical expense coverage, major medical expense coverage, hospital or medical service plan contract coverage and hospital and medical coverage provided to health care center members. For other categories of health insurance included under section 38a-469 of the Connecticut General Statutes, including but not limited to, hospital indemnity, disability income, accident only and specified disease and specified accident coverage, there is no contractual commitment to pay for medically necessary care. However, based on Public Act 11-55, licensed entities are prohibited from using an exclusion based solely on gender identity or expression, including an exclusion for gender reassignment and related services, or otherwise discriminating against insured individuals with gender dysphoria
There is an important note at the end of the bulletin...
Important Note: Although a blanket policy exclusion for gender transition and related services is prohibited, a health insurer, HMO or other entity, with respect to the coverages subject to sections 38a-488a [Individual and Group Mental Health Parity Statute - individual health insurance] and 38a-514 [Individual and Group Mental Health Parity Statute - group health insurance ] of the Connecticut General Statutes, may still perform medical necessity determinations on a case by case basis with respect to an insured's request for transgender services. However, if the request is denied on the basis the services are not medically necessary, the insured has the right to an independent review through the Department's External Review Program.